Gait & Posture 70 (2019) 141–147

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Gait & Posture

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Full length article

Functional range of motion in the upper extremity and trunk joints: Nine T
functional everyday tasks with inertial sensors
Mert Doğana, , Mertcan Koçakb, Özge Onursal Kılınça, Fatma Ayvata, Gülşah Sütçüa,
⁎

Ender Ayvata, Muhammed Kılınça, Özgür Ünverc, Sibel Aksu Yıldırıma

a
Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Hacettepe University, Ankara, Turkey
b
Department of Mechatronics Engineering, Faculty of Engineering, Izmır Katip Celebi University, Izmir, Turkey
c
Department of Machine Engineering, Faculty of Engineering, Hacettepe University, Ankara, Turkey

ARTICLE INFO ABSTRACT

Keywords: Background: Functional range of motion is defined as the required range of motions for individuals to maintain
Activities of daily living maximal independence, along with optimal conditions for activities of daily living. Intervention plans for re-
Inertial sensors habilitation are directed towards the acquisition of anatomical range of motion. However, this isn’t always
Tasks and performance analysis possible based on person’s etiology, prognosis, or severity of disease.
Functional range of motion
Research question: The aim of this study is to determine functional range of motion during different unilateral,
Kinematics of the upper extremity and trunk
joints
bilateral symmetrical and bimanual asymmetrical tasks of activities of daily living.
Methods: Participants completed nine basic activities of daily living (hand to head, hanging jacket, eating, wallet
placement to back pocket, washing hands and face, removing belt, water pouring, brushing teeth) linked ac-
cording to International Classification of Functioning, Disability and Health, while joint kinematics of the trunk
and upper extremity were recorded with inertial measurement units. Peak values of mean joint angles were
determined for each activities of daily living. MVN BIOMECH Awinda MTW2-3A7G6 sensors (Xsens
Technologies B.V. Enschede, Netherlands) were used for 3D kinematic analysis of activities.
Results: Forty-six healthy subjects (right-dominant) were included in this study. Range of motion requirements
of all activities were defined 37.85° extension, 91.18° flexion, 1.25° adduction, 39.45° abduction, 63.6° internal
rotation, 21.8° external rotation in the dominant shoulder, 124.17° flexion in the dominant elbow, 40.29° ex-
tension, 23.66° flexion, 18.31° supination, 12.56° pronation, 18.27 ulnar deviation and, 18.36° radial deviation
in the dominant wrist. Maximum trunk range of motions were found to be 29.75° flexion in C7-T1, 10.74° flexion
in T12-L1, and 24.16° flexion in L5-S1.
Significance: It is thought that the results of this research will contribute to the determination of normative data
needed for surgical interventions, technological rehabilitation devices and task-spesific rehabilitation programs
which based patient's motor skill level.

1. Introduction Intervention plans for rehabilitation usually directed towards the

The normal kinematic features of basic activities of daily living
(ADLs) such as eating, drinking, personal care, functional mobility,
wearing depend on range of motion (RoM), speed, efficacy, accuracy,
smoothness and coordination between the joints of the trunk and upper
extremity [1]. Especially, RoM in all directions are essential for ADLs.
When ADLs were impeded due to decreased RoM, these ADLs were
performed by using compensatory movement or assistance of other
peoples and adaptive instruments [2]. Therefore, maintaining or re-
storing RoM is the main objectives of many rehabilitation practices [2].
acquisition of anatomical maximal RoM of joints [2]. But, it is not al-
ways possible in relation to etiology, prognosis, or severity of the dis-
ease such as burn injury, muscle shortness, tendon or ligament con-
tractures, pain, muscle tone disorders, adhesive capsulitis, bone
fractures, plexus lesions, rheumatoid arthritis, and others [2–9]. All of
these informations reveal the need to determine the functional RoMs
defined as required maximal range of motion without limitations while
performing different daily tasks [10].
Kinematic analysis is an objective method for evaluating of func-
tional RoM to describe the extremities and trunk movements during

⁎
Corresponding author at: Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Hacettepe University, 06100 Ankara, Turkey.
E-mail addresses: ptmertdogan@gmail.com, mertdogan@hacettepe.edu.tr (M. Doğan).

https://doi.org/10.1016/j.gaitpost.2019.02.024
Received 18 December 2018; Received in revised form 1 February 2019; Accepted 24 February 2019
0966-6362/ © 2019 Elsevier B.V. All rights reserved.
M. Doğan, et al.
ADLs [10,11]. In previous studies, electromagnetic systems [5,12,13]
and optical systems [14–18] were used for determining functional
RoMs of upper extremity joints. These systems can be provide valid,
reliable, detailed and objective measurements [19] but spesific mate-
rials of these systems have difficult accessibility because of materials
are relatively expensive, non-portable and require a well-trained bio-
mechanical expertise. Therefore, the usability of these systems is not
common in clinical practice, and clinicans do not have access to ob-
jective data for evaluating patient’s impairment or motor performance.
A more accessible methods needed to evaluate RoM in clinics [20]. In
this respect, inertial measurement units (IMUs) are used to evaluate the
performance of the upper limb motor function during ADLs in the lit-
erature [20–23]. Furthermore, potential solutions of IMUs allows to
determine kinematics without being restricted to laboratory area and
clinicians who inexperienced in the field of biomechanics can evaluate
individuals easily in clinical settings [20]. IMUs are portable and more
cheaper than camera based motion-capture systems. Also, the validity
of joint kinematic assesments of IMUs has been confirmed with respect
to optoelectronic motion analysis systems [20,24–26].
In previous studies, shoulder and elbow joint RoMs were analyzed
for 66 different ADL tasks which 40 focused personal care, seven on
feeding, and the rest on variety of daily, leisure, and work activities [2].
According to our knowledge, functional RoMs of the upper extremity
and spesific trunk joints were not evaluated together. Additionally,
there is no study investigating the kinematic properties of bimanual
asymmetric activities (e.g. water pouring, removing belt, teeth
brushing) which right and left upper extremities have different tasks at
the same time. In this context, the purpose of present study is to define
the functional RoM of the upper limbs and trunk joints in healthy in-
dividuals during unilateral (hand to head, hanging jacket, eating and
wallet placement to back pocket) and bilateral-bimanual (washing face
and hands, remove belt, brushing teeth, water pouring) functional ev-
eryday tasks.
2. Material and methods
2.1. Participants
The individuals who are 20–40 years old, right dominant, have
painless upper extremity and trunk movement were included in this
study. The individuals who have diagnosed the neurological or ortho-
pedic problem that prevents upper extremity and trunk movements
were excluded. This study was conducted in the Hacettepe University,
Faculty of Health Sciences, Department of Physiotherapy and
Rehabilitation, Technological Rehabilitation Research Laboratory.
Written informed consent was obtained from all participants, as ap-
proved by the Ethics Committee of the Hacettepe University (KA-
17051). Physical and demographic characteristics (age, weight, height,
body mass index, flare length, distance between right and left acro-
mion) of the participants were all recorded.
2.2. Experimental protocol
MVN BIOMECH Awinda MTW2-3A7G6 sensors (Xsens Technologies
B.V. Enschede, Netherlands) were used for 3D kinematic analysis of
activities. IMUs consist of a triaxial accelerometer, triaxial magnet-
ometer and triaxial gyroscope. A kalman filter (Xsens Kalman Filter,
XKF) was used to generate 3D reconstruction for body segment position
and orientation. These sensors tend to yield valid and reliable results
compared to optical motion analysis systems, which had been accepted
as the gold standard in prior studies of biomechanical analysis
[20,24–27].
Bilateral shoulder, elbow, wrist, and C7-T1, T12-L1, L5-S1 joint
kinematic data were recorded with IMU sensors, wireless station and
142
Gait & Posture 70 (2019) 141–147
Xsens MVN Studio 4.6 was used to follow the IMU orientations with
respect to an earth-based coordinate frame [28]. The biomechanical
model of this system associated with a model from Optotrak motion-
based system [29,30]. Thus, this system able to quantify joint kine-
matics of complex movements [20]. Gloves, vests, and velcro tapes
were used to affix sensors to upper extremity and trunk for an effective
analysis.
The participant was asked to stand N-Pose for calibration process, as
intructions in MVN BIOMECH user manual. Measurements were eval-
uated for individuals in an anatomical position, performing activity,
and then returning to the anatomical position. Each measurement was
repeated three times with 60 s intervals. The mean values of kinematic
data determined each individual’s functional RoM of joints. The joint
angle definitions followed by the International Society of Biomechanics
[31]. Characteristics of materials, as well as their measurements, were
standardized for every individual.
2.3. Activities
Nine ADLs were selected by examining the studies in the literature
[12,13,32,33] and associated clinical experience of study group with
International Classification of Functioning, Disability and Health (ICF)
subdomains. ICF linking process was constructed by three PhD phy-
siotherapist and they followed Cieza et al.’s linking rules [34]. Within
the scope of the study unilateral; hand to head (HTH), hanging jacket
(HJ), eating (EAT), wallet placement to back pocket (WPBP), bilateral
symmetric; washing hands and face (WHeWF), and bimanual asym-
metric; removing belt (RB), water pouring (WPo), brushing teeth (BT)
activities were evaluated. Activity selection criteria showed in Table 1.
2.3.1. Unilateral activities
• Hand to head: Participants were asked to touch their right hand to
the center point of their head.
• Hanging jacket: Participants were asked to hang a standard jacket
to 175 cm height hanger and they were positioned 30 cm opposite
the center of hanger.
• Eating: Participants were asked to sit in an upright position on
45 cm height chair. The plate and spoon were placed 15 cm forward
on 75 cm height table. The participants were asked to take the spoon
3 times to their mouths with their right hands.
• Wallet placement to back pocket: The wallet was placed 15 cm
forward on 75 cm high table. The participants were asked to take
wallet and put their back pocket.
2.3.2. Bilateral symmetric activities
• Washing face and hands: A basin was laid on 75 cm high table for
representing the washbowl. The participants were asked to do these
activities in a similar way as they did in daily life. However, water
was not used performing the activities. Each participant washed his
hands three times. The WF activity was performed in same protocol.
2.3.3. Bimanual asymmetric activities
• Removing belt: Each participant was asked to wear the appropriate
belt and stand anatomical position. The participants were asked to
remove belt using both hands and keep it in the right hand.
• Brushing teeth: The toothpaste and toothbrush were placed on the
shelf of 125 cm height. The distance between toothpaste and
toothbrush was 15 cm and they placed parallel to each other. Firstly,
the participants were asked to take toothbrush with right hand and
take toothpaste with left hand on the shelf. Secondly, the partici-
pants were asked to squeeze toothpaste into toothbrush and put
M. Doğan, et al. Gait & Posture 70 (2019) 141–147

toothpaste on the shelf. Thirdly, the participants were asked to

Similiar, Aizawa et al. [12], Magermans et al. [5], van Andel et al. [8]
brush three times circularly with toothbrush on their right hand and
put toothbrush on the shelf.
• Water pouring: The pitcher and glass were placed on the 45 cm
high table. The distance between pitcher and glass was 15 cm.
Pitcher filled with 1 L of water. Firstly, the participants were asked
to lean forward to take pitcher (with right hand) and glass (with left
hand) to upward simultaneously. Secondly, the participants were
asked to fill the glass with water from pitcher. Lastly, the partici-
pants were asked to put glass and pitcher to table.

2.4. Statistical analysis

Similiar, van Andel et al. [8]

Statistical analysis was performed with the MATLAB R2016a

(MathWorks, Natick, MA, USA). The weighted linear regression method
Magermans et al. [5]

Bible et al. [44,45]

Aizawa et al [12].

was used for normalization, while descriptive statistics were given with
Inada et al. [33]
Referred Article

mean ± standard deviation (X ± SD).

3. Results
None

None
None

Forty-six (22 males, 24 females) healthy subjects were included. The

mean age was found to be 25,74 ± 4,18 years. The mean height and
d5301, Regulation defecation.

flare length was found to be 171,22 ± 8,22 and 170,60 ± 10,16 cm.
d5100, Washing body parts.
d5100, Washing body parts.
d5401, Taking off clothes.

The mean length between bilateral acromions was found to be

d5201, Caring for teeth.
d5202, Caring for hair.
Linked ICF Parameters

32,91 ± 3,84 cm. The mean weight was found to be 67,33 ± 15,11 kg
and the mean body mass index was found to be 22,73 ± 3,55 kg / m2.
d560, Drinking.
d540, Dressing.

The maximum angles and functional RoMs of the unilateral tasks,

d550, Eating.

bimanual asymmetrical activities, bilateral symmetrical tasks, are

shown in Tables 2–4. The functional extension/flexion range of joints
showed in Fig. 1.
With this study, lateral flexion of T12-L1 joint and rotation of C7-T1,
L5-S1 and shoulder joints showed highest RoM degrees in HJ; the lat-
Toilet Hygiene, Functional Mobility

eral flexion of C7-T1 and L5-S1 joints were highest in WPBP. The ulnar/
Eating and Functional Mobility

radial deviation range of the wrist was highest in WPo. The abduction/
Personal Care and Hygiene

adduction range of the dominant shoulder, pronation/supination range

of the dominant wrist, and flexion/extension range of dominant elbow
Functional Mobility

were highest in BT (Table 3).

The pronation/supination range of the dominant elbow was highest
Personal Care

Personal Care
Personal Care
Related ADL

in WH and flexion/extension range of C7-T1 joint was highest RB,

Wearing

flexion/extension range of T12-L1, L5-S1, and dominant wrist joints

Eating

were highest in WF. Also, functional RoMs of dominant and non-

dominant extremities were found similiar in bilateral symmetrical tasks
(Table 4).
Bimanuel Asymmetrical /Multi Motor Tasks
Bimanuel Asymmetrical /Multi Motor Tasks

4. Discussion
Unilateral/ Outside Visibility Area

Studies evaluating the upper extremity kinematic characteristics of

daily living activities in healthy individuals play an important role in
establishing the reference values needed for accurate and objective
Bimanuel asymmetrical
Unilateral / Head over
Unilateral / Head over

Bilateral/ Symmetrical
Bilateral/ Symmetrical

determination of activity limitations in various diseases [2,8]. There-

Unilateral / Sitting

fore, studies are needed to evaluate upper extremity activities under

different conditions in the literature. Also trunk stabilization plays
fundamental role for the quality and accuracy of upper extremity
Activity selection protocols and ICF linking.

movements [35,36]. Most of the previous studies, ignoring this situa-

Type

tion, the only upper extremity kinematics investigated [2,17,33,37]. In

this respect, this study differs from literature in terms of investigate the
trunk and upper extremity movements with IMU sensors.
Wallet placement to back pocket

The activities included in previous studies were chosen according to

different approaches. The activities were selected from the parameters
of the functional evaluation scales [12,13,18], patients’ feedbacks
[38,39], and pilot or previous studies in the literature [11,40,41]. In
this study, activities were selected from the previous studies, and
Washing hands
Hanging jacket

Brushing teeth
Removing belt

Water Pouring
Hand to head

Washing face

clinical experience of the research team, and activities are associated

with the sub-domains of ICF. For this reason, this is the first study in
Activity
Table 1

Eating

which ICF linking is used systematically in kinematic research.

In the previous studies, the activities were evaluated in the

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M. Doğan, et al. Gait & Posture 70 (2019) 141–147

Table 2
Functional range of motions of dominant extremity and trunk during unilateral tasks.
Joints Activities Right (+) / Left (-) Lateral Flexion Right (+) / Left (-) Axial Rotation Flexion (+) / Extension (-)

Minimum Maximum Range Minimum Maximum Range Minimum Maximum Range

Mean SD Mean SD Mean SD Mean SD Mean SD Mean SD

C7-T1 HTH 0,22 1,27 3,13 1,81 2,91 −0,47 1,74 1,06 1,97 1,53 19,3 2,86 20,68 3,13 1,38
HJ −0,94 1,32 2,35 1,8 3,29 −5,4 3,7 1,57 2,56 6,97 9,96 3,66 14,68 3,87 4,72
EAT −0,2 1,36 2,46 2,13 2,66 −0,55 1,78 0,05 2,7 0,6 15,52 3 18,31 3,53 2,79
WPBP −0,49 0,97 3,6 2,62 4,09 −3,89 2,29 0,56 2,45 4,45 18,25 3,91 23,49 5,52 5,24
T12-L1 HTH −0,55 0,39 0,06 0,29 0,61 −0,34 0,73 −0,06 0,74 0,28 0,88 0,66 1,08 0,63 0,2
HJ −1,42 1,05 0,39 0,57 1,81 0,66 1 2,59 1,27 1,93 0,54 1,21 1,07 1,13 0,53
EAT −0,17 0,83 0,46 0,7 0,63 −0,05 0,92 0,31 1,06 0,36 5,05 2,06 8,63 1,9 3,58
WPBP −0,5 0,79 0,8 0,91 1,3 −0,76 1,17 1,96 1,02 2,72 1,01 0,76 3,36 1,18 2,35
L5-S1 HTH −1,23 0,88 0,13 0,64 1,37 −0,77 1,65 −0,14 1,66 0,63 1,97 1,49 2,43 1,41 0,46
HJ −3,22 2,33 0,85 1,31 4,08 1,48 2,25 5,81 2,87 4,33 1,13 2,76 2,41 2,54 1,28
EAT −0,44 1,85 1,01 1,55 1,45 −0,05 2,07 0,66 2,41 0,71 11,38 4,64 19,43 4,3 8,05
WPBP −1,06 1,74 1,65 2,02 2,71 −1,75 2,63 4,47 2,3 6,22 2,27 1,71 7,58 2,65 5,31
Shoulder Abduction (+) / Adduction (-) Internal (+) / External (-) Rotation Flexion (+) / Extension (-)
Right HTH 9,57 4,33 38,89 10,89 29,32 −13,09 8,63 55,4 18,5 68,49 4,85 5,47 89,88 21,33 85,03
HJ 8,17 5,26 30,21 12,77 22,04 −13,71 11,89 63,62 16,51 77,33 −6,9 7,92 91,18 14,24 98,08
EAT 10,27 5,05 31,84 10,16 21,57 −9,82 10,11 21,4 12,78 31,22 4,41 7,04 46,03 14,99 41,62
WPBP 9,28 3,87 22,7 8,33 13,42 −21,77 12,41 20,97 14,18 42,74 −37,85 10,68 21,52 15,25 59,37
Wrist and Elbow Ulnar (+) / Radial (-) Deviation Pronation (+) / Supination (-) Flexion (+) / Extension (-)
Right Wrist HTH 2,81 5,63 5,55 7,43 2,74 −18,31 11,75 −11,45 10,16 6,86 −9,05 9,09 7,8 11,23 16,85
HJ −9,74 9,12 8,86 10,69 18,6 −13,72 13,43 7,1 10,68 20,82 −28,96 15,53 −9,05 15,99 19,91
EAT −1,98 10,4 5,9 11,58 7,88 −15,45 13,68 −1,41 11,2 14,04 −40,29 12,61 −12,46 10,63 27,83
WPBP −1,87 8,88 4,85 8,86 6,71 −18,19 12,78 3,27 17,57 21,46 −30 14,29 −4,36 23,66 25,64
Right Elbow HTH * * * * * 22,6 16,03 55,09 18,44 32,49 8,56 7,66 110,9 22,48 102,34
HJ * * * * * 14,58 17,2 83,87 24,78 69,29 10,13 8,63 91,67 20,81 81,54
EAT * * * * * 18,68 16,91 67,23 22,71 48,55 13,84 9,07 120,6 16,81 106,76
WPBP * * * * * 14,8 18,35 107,93 23,89 93,13 11,43 7,48 50,83 35,9 39,4

HTH: Hand to head, HJ: Hanging jacket, EAT: Eating, WPBP: Wallet placement to back pocket, *: Not analyzed.

Table 3
Functional range of motions of dominant extremity and trunk during bimanual asymmetrical tasks.
Joints Activities Right (+) / Left (-) Lateral Flexion Right (+) / Left (-) Axial Rotation Flexion (+) / Extension (-)

Minimum Maximum Range Minimum Maximum Range Minimum Maximum Range

Mean SD Mean SD Mean SD Mean SD Mean SD Mean SD

C7-T1 RB 0,01 1,19 2,03 2,16 2,02 −0,19 1,84 0,31 2,08 0,5 17,52 3,44 29,75 5,58 12,23
WPo −0,98 2,32 0,67 1,97 1,65 −0,36 1,31 1,51 1,29 1,87 18,95 4,07 23,68 3,51 4,73
BT −1,01 1,1 0,84 1,67 1,85 1,26 2,23 2,12 2,43 0,86 17,12 3,13 20,62 3,58 3,5
T12-L1 RB 0,17 0,5 0,35 0,44 0,18 0,35 0,58 0,79 0,99 0,44 1,4 1,56 3,23 2,29 1,83
WPo −1,34 0,81 −0,01 0,66 1,33 −0,04 0,34 0,4 0,62 0,44 1,21 0,75 6,26 2,43 5,05
BT −0,57 0,42 0,05 0,29 0,62 0,34 0,87 0,69 0,84 0,35 0,8 0,71 1,55 0,95 0,75
L5-S1 RB 0,35 1,15 0,78 0,96 0,43 0,79 1,3 1,77 2,22 0,98 3,16 3,51 7,27 5,15 4,11
WPo −3,04 1,83 −0,01 1,44 3,03 −0,1 0,76 0,85 1,4 0,95 2,72 1,69 14,09 5,47 11,37
BT −1,3 0,97 0,11 0,66 1,41 0,74 1,96 1,53 1,89 0,79 1,79 1,59 3,48 2,14 1,69
Shoulders Abduction (+) / Adduction (-) Internal (+) / External (-) Rotation Flexion (+) / Extension (-)
Right RB 9,23 5,01 19,4 5,91 10,17 −12,76 12,45 9,68 12,76 22,44 −11,86 10,61 2,13 10,56 13,99
WPo 8,55 3,94 27,16 10,36 18,61 −12,32 8,22 20,99 10,58 33,31 1,52 4,84 35,92 9,85 34,4
BT 8,19 4,08 39,45 10,68 31,26 −10,47 9,16 24,98 13,76 35,45 −1,18 6,78 55,01 14,4 56,19
Left RB 10,08 4,49 19,64 5,57 9,56 −8,96 10,7 12,02 13,01 20,98 −6,76 9,61 5,83 8,39 12,59
WPo 822 4,9 11,82 6,36 3,6 −9,11 9 23,38 10,8 32,49 2,84 4,25 32,36 12,79 29,52
BT 9,18 4,08 23,98 11,5 14,8 −15,82 10,26 21,67 13,55 37,49 −1,41 5,05 42,49 13,92 43,9
Wrists Ulnar (+) / Radial (-) Deviation Pronation (+) / Supination (-) Flexion (+) / Extension (-)
Right RB −8,69 9,04 5,69 9,28 14,38 −13,95 13,72 3,78 12,83 17,73 −19,18 13,2 −3,94 13,24 15,24
WPo −11,68 9,38 16,96 8,96 28,64 −17,76 11,43 9,5 12,37 27,26 −24,94 11,22 −9,59 8,97 15,35
BT −18,27 9,71 2,59 8,53 20,86 −14,78 11,45 12,56 11,92 27,34 −18,09 13,39 −5,9 11,48 12,19
Left RB −9,51 10,56 3,1 5,88 12,61 −16,41 13,28 3,47 12,37 19,88 −13,08 14,32 1,92 13,36 15
WPo 3,12 4,51 20,93 11,71 17,81 −17,63 11,26 1,71 6,58 19,34 −27,06 10,11 −7,21 7,97 19,85
BT −21,43 12,17 2,9 8,59 24,33 −17,65 11,25 12,63 10,24 30,28 −14,62 12,33 −5,3 14,34 9,32
Elbows Ulnar (+) / Radial (-) Deviation Pronation (+) / Supination (-) Flexion (+) / Extension (-)
Right RB * * * * * 16,64 17,12 81,09 24,97 64,45 10,26 8,8 63,96 18,78 53,7
WPo * * * * * 24,73 15,68 114,15 16,18 89,42 11,5 7,16 76,05 15,58 64,55
BT * * * * * 18,5 15,58 108,47 24,36 89,97 10,45 8,43 124,17 11,28 113,72
Left RB * * * * * 20,51 18,57 92,77 24,95 72,26 9,27 7,35 61,02 22,27 51,75
WPo * * * * * 22,81 15,52 114,05 14,64 91,24 10,61 7,28 56,83 16,04 46,22
BT * * * * * 26,82 17,73 112,63 23,73 85,81 8,52 6,83 87,69 14,59 79,17

RB: Removing Belt, WPo: Water Pouring, BT: Brushing Teeth, *: Not analyzed.

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Table 4
Functional range of motions of dominant extremity and trunk during bilateral symmetrical tasks.
Joints Activities Right (+) / Left (-) Lateral Flexion Right (+) / Left (-) Axial Rotation Flexion (+) / Extension (-)

Minimum Maximum Range Minimum Maximum Range Minimum Maximum Range

Mean SD Mean SD Mean SD Mean SD Mean SD Mean SD

C7-T1 WH 0,02 1,21 1,2 2,38 1,18 −0,24 1,63 0,32 1,39 0,56 17,26 3,34 21,54 3,9 4,28
WF −0,13 1,28 1,77 2,03 1,9 −0,77 1,88 0,08 2,2 0,85 11,37 4,36 20,5 3,54 9,13
T12-L1 WH 0,02 0,36 0,13 0,63 0,11 0,07 0,39 0,76 0,73 0,69 0,59 0,95 7,6 1,93 7,01
WF 0,09 0,34 0,29 0,79 0,2 0,04 0,4 1,04 0,94 1 0,86 1,11 10,74 1,65 9,88
L5-S1 WH −0,02 0,86 0,21 1,35 0,23 0,16 0,88 1,7 1,68 1,54 1,32 2,14 17,1 4,35 15,78
WF 0,09 0,86 0,57 1,63 0,48 0,09 0,9 2,34 2,06 2,25 1,93 2,5 24,16 3,72 22,23
Shoulders Abduction (+) / Adduction (-) Internal (+) / External (-) Rotation Flexion (+) / Extension (-)
Right WH 8,37 4,26 13,95 7,32 5,58 −12,06 8,02 31,08 10,87 43,14 −3,94 5,39 44,37 11,53 48,31
WF −1,25 7,22 14,03 9,9 15,28 −11,92 8,13 37,19 11,39 49,11 −3,51 5,69 57,49 14,76 61
Left WH 6,93 6,23 13,02 6,8 6,09 −12,49 8,94 30,75 10,44 43,24 −0,56 4,58 44,85 11,29 45,41
WF −2,52 7,92 13,92 10,16 16,44 −10,93 8,63 37,5 12,02 48,43 −0,07 4,93 56,43 13,04 56,5
Wrists Ulnar (+) / Radial (-) Deviation Pronation (+) / Supination (-) Flexion (+) / Extension (-)
Right WH 2,19 6,02 8,58 12,69 6,39 −16,77 10,96 −0,72 12,93 16,05 −18,49 14,68 −7,89 22,56 10,6
WF 3,19 5,82 18,36 10,63 15,17 −17,06 11,81 −6,49 11,36 10,57 −39,6 13,07 −10,14 10,3 29,46
Left WH 0,53 8,15 8,48 15,92 7,95 −18,89 11,85 −5,2 9,89 13,69 −17,09 14,76 −3,55 19,4 13,54
WF 3,69 4,99 17,28 12,83 13,59 −18,76 11,18 −10,81 9,16 7,95 −37,8 15,79 −7,31 8,62 30,49
Elbows Ulnar (+) / Radial (-) Deviation Pronation (+) / Supination (-) Flexion (+) / Extension (-)
Right WH * * * * * 23,6 18,54 101,89 35,94 78,29 10,98 8,6 64,07 15,12 53,09
WF * * * * * 25,6 18,68 93,52 22,82 67,92 12,19 9,01 119,8 15,7 107,61
Left WH * * * * * 22,44 17,68 95,92 41,11 73,48 9,43 7,72 61,88 15,84 52,45
WF * * * * * 23,73 17,63 90,23 25,56 66,5 9,78 8,04 119,73 16,17 109,95

WF: Washing Face, WH: Washing Hands. *: Not analyzed.

Fig. 1. Joint's functional range of motion on flexion/extension movement.

unilateral pattern including the daily life requirements of personal care,
nutrition, functional mobility and communication [2,10]. However,
from functional point of view; most of the activities in our daily life
involve the simultaneous use of both hands in sametime. For example;
shopping, dressing, cooking, driving, keyboard writing activities are
largely based on the use of two upper extremities [42]. It is known that
bilateral extremities perform different functions simultaneously in a
complementary manner. Besides the unilateral upper extremity kine-
matics, there is a need for the assessment of symmetrical and asym-
metrical bimanual activities for determine the targets for rehabilitation

145
M. Doğan, et al.
correctly. In this respect, this study is the first to evaluate the trunk and
upper extremity joints concurrently with IMU sensors during bilateral
symmetrical (WH, WF) and bimanual asymmetrical activities (WPo, RB,
CT).
In a comprehensive review of the literature, the functional RoMs in
the shoulder joint were approximately 62° extension, 142° extension/
flexion, 115° abduction, and 127° adduction [2]. In previous studies,
functional RoMs were found 121°-135.7° flexion, 53° supination and
13°-120° pronation in the elbow joint and 50° extension, 45° flexion, 23-
40° ulnar deviation, and 15°-28° radial deviation in the wrist joint
[5,32,43]. A few studies assessed functional RoMs of cervical and
lumbar joints during ADLs [44,45]. According to Bible et al. cervical
functional RoMs during the 15 ADLs were 13° extension 32° flexion, 9°-
21° lateral bending, and 13°-57° axial rotation [44] and lumbar func-
tional RoMs were 3° extension, 49° flexion, 2°-11°lateral bending, and
2°-7° axial rotation [45]. In these studies, multi-joint RoMs were de-
scribed. Each joint was not examined separately, and it is not known
which joint belongs to the ROM. In this respect, this study measured the
trunk from different levels for the first time and gave more detailed
results compared to the literature. Furthermore, functional RoMs of
upper extremity and trunk joints were found smaller than previous
studies. It is thought that the differences between this study and the
literature are due to measurement methods and protocols and the re-
sults of our study will contribute to increase the activity diversity on the
literature.
During the bimanual asymmetric activities (WPo, RB, BT) evaluated
within the scope of the research, the mean values of the functional
RoMs were 23.98° adduction, 15.82° external rotation, 23.38° internal
rotation, 6.76° extension, and 42.49° flexion in the non-dominant
shoulder, and 39.45° adduction, 12.76° external rotation, 24.98° in-
ternal rotation, 11.86° extension, and 55° flexion in the dominant
shoulder. In accordance with the literature, the extremity responsible
for stabilization was found to require less RoM compared to the limb
responsible for manipulation (49). It is thought that these results are
closely related to the characteristics of the activities evaluated. In order
to obtain more precise conclusions, studies that examine the bimanual
activity variations, angular velocity and acceleration data other than
functional RoMs are needed in more detail.
Most of studies in the literature, ‘plane of elevation’, ‘elevation
angle’ and ‘rotation angle’ terms used to describe movement [2,8]. In
addition, it is seen that it is difficult to compare the results in literature
because of insufficiently explained experimental protocols and the re-
sults of studies which are influenced by the physical characteristics of
the individuals and environmental variables. Therefore, in this study,
environmental variables and the experimental protocol were standar-
dized, and results were expressed in compliance with the clinical pre-
sentation. In conclusion, 9 different movements including bimanuel
activities in the trunk and upper extremity functional RoMs were re-
vealed. These results are thought to be guiding in follow-up of patients
in the clinic and in technological product development processes (ro-
botics, mechanical prosthesis etc.).
There are some limitations of this study. The scapula and finger
kinematics were not analyzed. It is also known that scapula and finger
movements are important for the activities used frequently in daily life.
Our study sample was chosen from young people. It is considered that it
is necessary to include older / younger populations in the researches in
order to determine more comprehensive normative data of daily living
activities. Because it is thought that the range of motion requirements
of ADLs may be different within various age groups.
5. Conclusions
The results of this study showed that RoM requirements of nine
different unilateral, bimanual asymmetrical and bilateral symmetrical
activities. It is tought that these results will contribute to determine
priority of task-spesific rehabilitation programs based patient's motor
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Gait & Posture 70 (2019) 141–147
skill level, and to determine requirements of normative data for sup-
portive technological rehabilitation approaches.
Fundings
This research did not receive any specific grant from funding
agencies in the public, commercial, or not-for-profit sectors.
Declaration of interest
None.
Author contributions
MD contribute to kinematic analysis of the nine ADLs. MeK con-
tributed to analysis of data. MD, SAY, MuK, OU and EA contributed to
the study design and plan. MD, GS, OOK and FA contributed to the
interpretation of the date and creation of the manuscript. All authors
confirmed and approved the final manuscript.
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